Do patients require routine hematocrit testing following uncomplicated cesarean delivery?

Abstract

Background: Cesarean delivery is associated with increased risk of hemorrhage, and this necessitated the practice of routine hematocrit testing to detect anemia and the need for blood transfusion. Objectives: To ascertain the necessity of this routine investigation and to identify factors predictive of anemia following uncomplicated cesarean delivery at this clinical setting. Materials and Methods: A prospective observational study of 236 women who had uneventful cesarean delivery at term over a 12-month period. Relevant sociodemographic and obstetric data were extracted, and clinical assessment of the women including postoperative hematocrit was done on second postoperative day. Data were analyzed using SPSS version 16 for Windows. Multivariate logistic regression analysis was done to identify independent risk factors predictive of anemia postcesarean section. Results: Average age and parity of the women were 29.8 ± 4.9 years and 2.2 ± 1.5 respectively. Mean pre and postcesarean hematocrit was 35.2% ± 3.4% and 30.7% ± 4.0% respectively with an average drop of 4.6% ± 3.3%. Only 5.9% had hematocrit decline of >10% and none was transfused. Preoperative hematocrit ≤35% (P < 0.0001, OR: 4.43, 95% confidence intervals (CI): 2.00-9.80), fatigue (P = 0.04, OR: 3.92, 95% CI: 1.07-14.39), and conjunctival pallor (P = 0.02, OR: 5.01, 95% CI: 1.32-19.02) were independent factors predictive of anemia postcesarean delivery. Conclusion: This study suggests that routine postcesarean hematocrit testing is unnecessary following uncomplicated procedure but may be indicated in women with preoperative hematocrit ≤35%, postoperative fatigue, and conjunctival pallor.